The Hindu : Brazil's enviable health care system

Online edition of India's National Newspaper
Sunday, Jan 25, 2004

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National

Brazil's enviable health care system

By Kalpana Sharma

MUMBAI, JAN. 24. The Brazilian President, Luiz Inacio Lula da Silva, who will be the chief guest at the Republic Day parade, brings with him lessons on health care that the Health Ministry officials should heed. For at the hundreds of discussions that marked the recently-concluded World Social Forum, Brazil's record in providing universal health care stood out as a shining example of what poor countries can achieve.

Armando De Negri Filho, General Coordinator of the Latin American Association of Social Medicine, told The Hindu that Brazil's decision, taken way back in 1988, to introduce the right to universal and free health care as part of its Constitution, had stood the test of time. "All you need is an identity card establishing that you're a Brazilian citizen," he said, "and you can access free health care anywhere in the country." Today, 99 per cent of Brazil's population of 178 million people uses the national health care system.

The Constitutional provision was the outcome of pressure from below at a time when the country's health care system was facing a crisis. But since then, despite changes in government, Brazil has gradually built up an enviable health infrastructure.

According to Dr. Filho, today all the 5,800 municipalities in Brazil have specific budgets for primary health care. Although local governments receive funds from the Centre on a per capita basis, thereby ensuring that even poor municipalities get enough, they have to allocate 15 per cent of their income for health.

How does a poor country find the money to pay for such a universal health system? "From the general tax system," says Dr. Filho. An amendment to the Constitution in 2000 has laid down that a certain percentage of the budget is earmarked for health care. The national government has to put aside at least 7.9 to 9.4 per cent of the GNP for health, while state governments must give 12 per cent of their income for this purpose. As a result, says Dr. Filho, "The system pays for itself. Even the private sector wants to be part of it."

Also, a system of accountability has been established through health councils at the national, state and local levels. Half of these councils are made up of users who are elected. The rest of the council consists of health workers, government representatives and health providers.

The councils vote on the annual health budget. In addition, all the data is now posted on the Internet. Thus, any citizen who wants to see how much has been allocated for health and where it has been sent, can follow its trajectory.

Dr. Filho argues that such a system benefits not just people in terms of providing people health care but is also an avenue for creating additional employment.

For instance, two million people are working in the health care system and an additional 3.5 million are in the support services. "The first step is to accept that it is possible to provide national health for everyone."

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